This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Friday, 14 January 2011

No unsocial hours pay.

I just received a worrying email. I have promised the author that I will not give out the details of his/her trust location.

The trust that this person works for as a Nurse is trying to stop unsocial hours pay. The pay rate for nights, days, weekends etc will all be the same basic rate.

The unions are getting involved but if Nurses cannot strike how much power will they have to really fight it?

If this goes through in one trust it will go happen in others.

All staff Nurses work a mix of day shift, night shift, weekday shifts and weekend shifts every single month. Currently they get paid a slightly higher rate for working unsocial hours.

Our shifts are different every week. We work on no kind of pattern . The working week goes something like this for a staff nurse..

Ridiculous isn't it. My body clock is messed up. Every week has that kind of mix of shifts. But the fact that we get a slightly higher rate for doing nights keeps my monthly wage at a certain level.

If this goes through they will see their wages fall by hundreds of pounds a month. I know I would. I do lots of nights and weekends. And there is no opting out of them even if they refuse to pay unsocial hours.

This is not a good thing to happen at a time when cost of living is skyrocketing.

More staff nurses will quit. Hospitals are having to close beds because of lack of staff. That is how extreme the nursing shortage (which results from nurses refusing to work at the bedside because of poor conditions) is getting. The staffing has become so bad that even management knows that the situation is bad. Usually they will just keep beds open and make 2 RN's take 30 patients and then 6 more admissions. But when the best you can get is one RN for 36 beds then beds close.

28 comments:

The only thing keeping a lot of people working on the wards is the unsocial hours payments. If I'm going to lose that, I'll be looking for a 9-5 job, because I might as well do the 'easier' job for the same money.

Do you think they could actually get away with this cellar door. I don't want to believe that they can.

But I also will not support a strike. I know that makes me sound like a loser who deserves bad working conditions but I really can't bear to see the patients get fucked over any more than they already are. They have been taxed to pay for care all their lives! How can we walk out on them en mass?

Someone at work was telling me that her partner is a train conductor and he is on 30,000 after taxes and they get loads of overtime on top of it. And they are bored at work. Might be something to look into.

The patients are already being f*cked over Anne. One RN to care for so many means the majority on a medical ward get ignored as the RN has to look to the sickest. I still think that if a national strike were planned, it would never have to go ahead. If a date and time were set then government would have to take notice. It wouldn't have to effect frontline emergency care- it would start at 8am with no nurses for outpatients, walk-in centres, elective/daycase units and other low dependancy areas. This would progress during the day to a refusal to work through breaks by all nursing staff and a "work to rule". I doubt that it would get past the first 5 minutes before trusts and governments gave in. It will only work if the unions do their jobs and fork out to run commercials during Coronation Street and Eastenders style shows pointing out what an NHS ward is really like and setting an ultimatum this way. its worked for other countries, so why not here?

WTF? I don't want to think they can do this but what if they do? They will struggle to staff the hospital at night because nobody will want to work those hours for the pay. A potentially dangerous, under-staffed and unsuported working environment as it is now ( and in the day alone) becomes lethal at night. Before Dr Crippen bailed I remember one of his posts about how hospitals are becoming incresingly more dangerous for patients at night because of the lack of medical staff and on-site support, and now this. On my old stroke ward placement the majority of the drama went down in the night, as I assume is the case with most acute environments.

My local prison has 2 RN's at the least, working during the day. This increases depending on what is on at the health centre (different clinics, doctor visitations) but there is ALWAYS 2/3 Nurses on at night without fail. Why? Because the majority of shit goes down in the PM.

As much as I love my profession, I woulden't work for peanuts (AKA day shift rate) for night work. Ever. Nor would I give up a fricking day leave or whatever stupid ideas they will come up with.

Hmmm, maybe I will become a meteorologist like my partner. Good pay, won't get struck off and ruin my entire life over a simple mistake as mistakes are inevitable and accepted in that profession, and I get to sit on my bum all day. Bliss.

Working nights takes years off your life, and working evenings and weekends takes years out of your family time. Unsociable pay goes some way to compensate for this. If this pay is stopped, I am outta here.

There we have it then Anne, lets go now to Meteorology school and never look back!

In regards to what uknurse said. Nights ruin you, totally. I worked so many nights in the A&E a few years back in winter time and was so accustomed to night time my eyes hurt when I eventually broke the cycle and went to days and had to leave the house during sun hours! I'm pale/gaunt-looking the best of days too, and never looked very well after a stint on nights. Never again if the pay isn't worth it.

2. It is the 3rd largest employer in the World, after the Chinese Army and the Indian National Railways.

3. People like you on the front line are overworked and under resourced.

4. My own experience of the NHS has shown me examples of incompetent and top-heavy management, but my question is; where does the money go?

We need an NHS focused equivalent of Wat Tyler, the ex "Burning Our Money" blogger to unravel the leakage. Somebody with the insight, understanding and financial knowledge to assess the Emperor's clothing. Can you recruit such a spin-off?

They have threatened this at our trust. We have all said if this happens, we will be gone.

I do think that we *could* strike without endangering patient care- we could just refuse to answer phones or anything not patient care related. Not that management would care. They know we will not just walk out of a shift (and if we did, they would just report the RNs to the NMC). Can you imagine the field day the papers would have with a nursing strike?

The type of idiots that read the Daily Fail already think we are too posh to wash so I doubt that they would think any less of us for striking. If the unions organised things properly, ran adverts like the australian nurses are doing, played some of the YouTube footage from the US that you've posted at PrimeTime...we might actually get a bit of support. The worried well would certainly be behind us. We need to make people see that this really is their last chance to keep a free service. If the tories get their way we will all be social enterprises and there are only so many trusts that will be able to stay afloat. Do we really want a system thats run by charities or the church? How unbiased will they be?

"it's probably of no consolation but junior doctors get no extra pay for antisocial hours"

Yes they do. It is called banding and is given for working hours over something like 40hrs and for working antisocial hours. I get it. Are you making a more complicated argument than that? Because I doubt very much you receive base rate pay if you're working one-in-two weekends and you work in the NHS.

I think the difference between nurses and doctors is that nurses are paid per hour and so can get overtime or unsocial hours rates while doctors are salaried and get a flat percentage supplement based on their rostered hours.

Totally agree with dino nurse, there is no reason why nurses could not go on strike in the way she suggested. in the early 80'S nurses went on strike at the london hospital i worked at for aprox 4 days, I remember standing on a picket line outside the hospital gates and recieving a huge amount of support from the public. We ensured there was a skelaton staff on each ward and had a picket line rota so patients did not suffer. we also worked to rule so actually took our breaks ect. it is possible totake action without endangering patients if all staff work together and support each other this means those nursesw who will not take direct action supporting those that are willing too.

My spouse and I stumbled over here by a different website and thought I might as well check things out. I like what I see so i am just following you. Look forward to looking over your web page for a second time.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.